Can Cannabis Help Atypical Facial Pain?
Mar 26, 2020
Atypical facial pain (AFP) is a form of chronic pain that the endocannabinoid system might regulate. Cannabis can influence the endocannabinoid system, and so cannabis use may potentially help to decrease chronic pain caused by atypical facial pain.
Current research hasn’t looked at cannabis and atypical facial pain specifically. That being said, there are multiple studies confirming the benefits of cannabis for reducing chronic pain in numerous conditions. Some research has shown cannabis can help to reduce pain in those with neuralgia (facial pain). These results may indicate cannabis could also help reduce atypical facial pain through similar mechanisms.
Multiple cannabis strains exist that all have different chemical profiles and properties, although research is lacking regarding which strains would be most efficacious for specific conditions. Nevertheless, research is lacking regarding which strains would be most effective for specific conditions.
Cannabis is well-tolerated when prescribed for chronic pain. However, people with mental health conditions should avoid using cannabis containing THC without consent from a medical professional.
How Cannabis Works on Atypical Facial Pain
The endocannabinoid system (ECS) exists in all vertebrates and helps regulate crucial functions such as sleep, pain, and appetite. The human body produces its own cannabinoids, which modulate and activate its various functions, but as its name suggests, the endocannabinoid system can also be modulated and activated by cannabinoids found in the cannabis plant. Because the entire system was only discovered in the past 30 years, scientists still have much to learn about the myriad ways cannabis affects the human body.
To date, research has not been published examining the association between the endocannabinoid system and the pathophysiology of atypical facial pain.
What we know for certain so far is that the endocannabinoid system plays a role in pain signaling. More specifically, cannabis can help with neuropathic pain (caused by damage to nerves that communicate pain). This is important to consider since many people diagnosed with atypical facial pain have neuropathic pain.
Cannabis use is thought to decrease chronic pain symptoms by stimulating these cannabinoid receptors, mimicking natural processes of the endocannabinoid system that help to reduce pain. Atypical facial pain might be reduced through activating pathways in the endocannabinoid system that regulate pain through similar mechanisms to other conditions that cause pain.
Research on AFP and Cannabis
Research on cannabis and atypical facial pain is sparse. Atypical facial pain is also difficult to study as its diagnosis is defined by a medical professional’s inability to diagnose a specific cause.
The following studies on cannabis and pain — although mostly unrelated to atypical facial pain — may indicate the potential of cannabis to help decrease atypical facial pain.
- A systematic review published in the Journal of Oral & Facial Pain Headaches reviewed 24 studies looking at chronic neuropathic pain. Out of the 13 studies selected, the researchers concluded that cannabinoids provide a pain-relieving effect for chronic neuropathic pain conditions that were unresponsive to other treatments.
- In one review of 28 studies on chronic pain, researchers concluded that “there was moderate-quality evidence to support the use of cannabinoids for the treatment of chronic pain.”
- A review of the therapeutic uses of cannabinoids in trigeminal neuralgia confirmed that cannabinoids may prove useful in pain modulation for the clinical management of trigeminal neuralgia (a disorder that causes constant dull aching facial pain).
- In a 2016 study, researchers explored the potential benefits of cannabis for chronic pain in people who were resistant to conventional treatments. The results showed that cannabis helped to reduce pain and reduce the use of opioid medications.
- A 2018 review evaluated 16 studies on cannabis-based medicines for chronic neuropathic pain. Conditions examined included neuralgia (pain in the face) and other types of conditions such as central neuropathic pain. All cannabis-based medicines were shown to be superior to placebo for reducing pain intensity.
- The National Academies of Sciences, Engineering, and Medicine released a statement in 2017 as a testament to cannabis’s pain-relieving effects, stating that “there is conclusive or substantial evidence that cannabis or cannabinoids are effective for the treatment of chronic pain in adults.”
Overall it’s clear cannabis has positive effects for pain for many people. Research also shows cannabis can help with neuropathic pain, which is apparent in people with atypical facial pain.
All things considered, it does seem probable (although still unconfirmed) that cannabis could help with chronic pain caused by atypical facial pain in some individuals.
CBD and AFP
CBD has been shown to help reduce pain in several conditions, but the effects of CBD specifically on atypical facial pain have not yet been explored in clinical research.
The following studies outline what the research says about CBD’s effects on pain.
- A 2018 review assessed how well CBD works for chronic pain. The review examined studies published between 1975 and 2018 and focused on cancer pain, neuropathic pain, and fibromyalgia. The researchers concluded that CBD was effective for overall pain management and didn’t cause adverse side effects.
- One 2016 animal study showed that topical CBD decreases pain and inflammation associated with arthritis.
- The results from a 2017 study focused on CBD and pain in rats with osteoarthritis. The results showed that CBD was able to reduce joint pain in a dose-dependent manner. CBD administration helped to decrease the future development of nerve damage and pain in arthritic joints.
Researchers are still exploring the pain-relieving effects of CBD in more detail. For example, a study on CBD and hand osteoarthritis and psoriatic arthritis is currently underway with an estimated completion date in late 2020.
While cannabis is effective for treating conditions that cause chronic pain, there are potential side effects to consider.
Cannabis-based medicines that contain THC can cause short term side effects such as fatigue, dry mouth, perceptual changes, euphoria, red eyes, and increased appetite. Since THC is intoxicating, cannabis containing this cannabinoid can impair memory, increase anxiety, and paranoia in certain individuals.
CBD-based medicines are not intoxicating and have uncommon mild side effects such as stomach discomfort and tiredness.
While cannabis is safe for treating chronic pain, some people are more likely than others to become dependent on cannabis (roughly 10% of the adult population). The risk for abuse appears to be higher in those who begin chronic cannabis use as an adolescent.
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About Atypical Facial Pain
Atypical facial pain is a term that’s used for chronic pain in the face that doesn’t match any other conditions. It’s also called persistent idiopathic facial pain. Atypical facial pain doesn’t have any obvious causes, and can be debilitating to the point that you cannot function or perform normal daily activities. Chronic atypical facial pain unfortunately often leads to significant disability.
It’s thought that 26% of the population has experienced facial pain at some point in their lives.
Atypical facial pain can present in a number of different ways. It’s usually persistent, remaining more or less constant all the time, although some people find that atypical facial pain gets worse when they are tired or stressed.
Different people feel the pain in different ways, including:
- Aching or sore areas of the face
- Cramping or pinching on the nerve
- A pulling sensation in parts of the face
- Sharp, shooting, or stabbing pains.
Unlike another type of facial pain called trigeminal neuralgia, the pain can spread across parts of the face that aren’t connected to the trigeminal nerve. Atypical facial pain also generally causes pain on one side of the face, but it can be felt on both sides at times. It can be felt inside the mouth, and occasionally spread to the rest of the body.
Like other chronic pain conditions, atypical facial pain can significantly impact your general health. Atypical facial pain can lead to:
- Mental health disorders like depression and anxiety
- Insomnia, which in turn can worsen existing mental health disorders and affect the ability to concentrate at work or school
- Difficulty eating or chewing because of the pain
- A desire to avoid socializing or going out in public, out of concern that the pain will suddenly appear or get worse
Atypical facial pain typically goes underdiagnosed, so it’s important to persist when telling your doctor about your symptoms. Unfortunately, it can also be misdiagnosed and lead to unnecessary treatments, procedures, and surgeries which sometimes only causes more harm. Patients also get tossed from one doctor to another, often seeing pain specialists, dentists, maxillofacial surgeons, neurologists, and psychiatrists. Since there are no specific confirmatory tests, diagnosing it usually involves ruling out every other possible cause of your symptoms. Like other chronic pain disorders, atypical facial pain may sometimes have a psychogenic component, complicating diagnosis even further.
You can expect your doctor to carry out a number of tests, including blood tests and imaging, to rule out other conditions. Other conditions such as tumors, infections, inflammatory conditions, and other types of facial pain and headaches can also present with similar symptoms and must be ruled out. Part of the assessment will also be an evaluation of your mental health and an inquiry into possible depression or anxiety.
As mentioned above, there’s no visible cause for atypical facial pain. It’s caused by some kind of disruption or fault in the pain signals that are sent from the face to the brain. The nerves carrying pain signals become hypersensitive, having developed a “memory” for sending a pain message, and aren’t able to ‘switch off’ the pain message when there’s no cause for it.
Often, atypical facial pain occurs after an infection or injury to the affected area, with pain persisting long after the original cause has healed. It can also be precipitated by surgery or other procedure, which sometimes become the start of an endless nightmare of chronic facial pain. At other times, it can occur after some sort of trauma such as a car accident or other type of accident. Or it can just come on spontaneously with no clear reason for the start of the pain.
It’s very difficult to treat atypical facial pain because it doesn’t respond to usual medications that provide pain relief. As a matter of fact, it is often diagnosed only after multiple therapies are not effective.
There’s no single treatment that works for everyone with atypical facial pain, but some treatments that have been successful include:
- Antidepressants and anticonvulsants which can decrease pain signals between nerves in the affected area.
- Pulsed radiofrequency ablation (PFR) and peripheral nerve field stimulation (PNFS) can help disrupt the pain messages to the brain
- Botulinum toxin (botox) injections which work by decreasing nerve sensitivity and weakening muscles in the affected area.
- Psychotherapy can help people find ways to cope with the pain and reduce the ways it impacts on their life
- Biofeedback or neurofeedback which can help sufferers adapt to and ignore pain signals.